{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA L HOOD","gend":1,"currentgend":"","add":"205 N 2nd St","city":"Conway Springs","state":"KS","zip":"67031","dob":"1958-09-22","age":"","mstatus":"","insh":"K44015107","cliId":"","pno":"6204563519","cno":"6204563519","email":"brendalhood47@yahoo.com","ename":"","eno":"","pphy":"HEBA FERGUSON","ppno":"3166872651","pcpadd":"7150 E HARRY ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67207-2914","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDCENTERS PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1881603421","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44015107","medicareid":"1FJ7F57DU51","medicaidid":"1FJ7F57DU51","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I130","I5030","N1831","Z86711","F1120","E6601","Z6843","F339","Z719","M539","H61312","L4050","E1122","E1169","D509","G2581","Z6844","E782","G44009","I2510","E785","I2699","N950","L89893","Z79899","Z4800","M170","G4733","I10","M549","I499","W07XXXD","Z7901","Z79891","Z7985","Z9181"],"date":["2026-06-10","2026-06-10","2026-06-10","2026-06-02","2026-06-08","2026-06-02","2026-06-08","2026-06-02","2026-06-08","2026-04-08","2026-02-04","2026-06-02","2026-06-10","2026-06-02","2026-06-02","2026-06-02","2026-04-22","2026-06-02","2026-06-02","2026-06-08","2026-06-08","2026-06-08","2026-06-08","2026-06-10","2026-06-02","2026-05-05","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-03-05","2026-06-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","WARFARIN SODIUM","2 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","GEMTESA","75 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","TOUJEO SOLOSTAR","","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","150 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","SOTALOL HYDROCHLORIDE","80 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","MOUNJARO","15 MG","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/ULTRA-FINE\/31G X 5MM","","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","JARDIANCE","25 MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}